The Effect of High Baseline Pain on Impairment Outcomes One Year After Distal Radius Fracture

Objective The purpose of this study is to evaluate whether high baseline pain predicts impairment outcomes in grip strength or wrist range of motion (ROM) at one year after a distal radius fracture (DRF). Impairments occur for less than 15% of patients. Methods: In this cohort study patients with a DRF were recruited from a hand clinic in London, Ontario. This data was collected at two evaluation time points: at baseline (within the first 10 days after fracture) and at one year after fracture. Baseline pain was assessed using the pain subscale of the Patient-Rated Wrist Evaluation (PRWE) and classified as high if it exceeded 35/50. Grip strength and ROM scores were evaluated at one year and compared to previously defined patient satisfaction benchmarks. Relative risks (RR) were calculated to assess the magnitude of impairment risk with high pain. Results: A sample of 277 patients with a DRF, with a mean age of 60 ± 11.5 years, was included. The majority of relative risks were not significant and did not support that high baseline pain is a clinically important risk factor for poor impairment scores: grip strength RR 1.5 CI (0.69 – 3.09) and ROM’s flexion-extension RR 1.2 CI (1.05 – 1.36), radial-ulnar deviation RR 1.1 CI (0.94 – 1.29) and pronation-supination RR 1.0 CI (0.86 – 1.38). Conclusion: Therapists can reassure patients that even when high pain is present after a fracture, the potential for recovery of grip strength and ROM is not much different from patients with lower pain. Keywords: Pain, grip strength, range of motion, physical impairment, patient satisfactio